Harvey Cushing: A Life in Surgery (review)

Trigeminal neuralgia or 'tic douleureux' results from pressure on the fifth cranial nerve and is expressed as intense in the anatomic sites irrigated by that nerve, namely, the eyes, lips, nose, scalp, forehead, and jaw. The pain, described as electric-shock-like by sufferers, is so intense that early sufferers occasionally committed suicide. Although the pressure on the nerve may have a variety of common causes such as infection or tumour, the disease itself is relatively rare, affecting no more than five in a hundred thousand individuals per year. Even with that low rate of incidence, however, tic douloureux comprises 5 per cent of neurological disorders and the patient group attached to the disease in the United States, the Trigeminal Neuralgia Association, presently claims over twenty-five thousand members. The subject of Michael Bliss's most recent and scrupulous biography, Harvey Cushing (1869–1939), scored his first success as America's and indeed the world's most famous neurosurgeon of the first half of the twentieth century by inventing a method for surgically separating the cranial nerve from the brain where it enters the spinal cord. Patients have profited ever since.

A student and soon-to-be colleague of William Halsted (1852–1922), inventor of the radical mastectomy for breast cancer and noted cocaine addict, at Johns Hopkins, Cushing's work on tic douleureux at the age of thirty solidified what was becoming an enviable reputation for careful yet daring brain surgery. Following postgraduate research in Berne where he made significant observations of the reaction of the brain to compression using dogs and monkeys, Cushing returned to Baltimore to become America's foremost neurosurgeon and to pursue parallel lines of research in brain physiology and brain pathology. There and later as Surgeon-in-Chief of the Peter Bent Brigham Hospital in Boston, he maintained a lifelong interest in the functioning of the endocrine system whose central organ he encountered through the window of the various pathologies of the pituitary gland. At the same time he amassed an enormous collection of tumours arising from the tissues that envelope the brain – meningiomas – that were issued in a monumental eight-hundred-page publication just before his death.

Since surgery entails a great deal of craft knowledge, and many procedures can be learned only at the operating table, part of Cushing's formidable reputation is based on the fact that in addition to being an innovator, he was also an excellent and indefatigable operator; he retired only after having completed more than two thousand operations during the course of which he trained an entire generation of brain surgeons. Excluded from that extraordinary number of operations – and it is well to remember that, at the time, many procedures took eight to ten hours to perform – are those carried out during the First World War, where Cushing operated as a front-line surgeon, kept a diary that later become a book, and pioneered the use of electromagnets to extract metallic bodies from the brain. As Cushing's wife remarked while gazing at his sixteen volumes of collected papers: 'Such industry.'

As it turns out and as Bliss records in fine detail, Cushing's wife saw his papers about as often as she saw their author, which wasn't very often. An absent and somewhat distant father, and competitive to a fault, Cushing drove himself and others with an intensity that shocked and astonished his contemporaries. One of his students, Hugh Cairns (1896–1952), who would go on to become professor of surgery at Oxford University, once wrote to his wife complaining of Cushing that: 'He cursed me in front of everyone in the operating room the other day for doing something he had told me to do the previous, and when I protested hotly with, I imagine, blazing eyes, he lied promptly and with perfect technique.' As the Bliss biography makes abundantly clear, Cushing was also a world-class bully.